BCG Vaccine

A message from the Mayor of London’s TB Ambassador Emma Thompson and her son Tindy on World TB Day

BCG Vaccination (TB vaccine)

Bacille Calmette-Guérin (BCG) vaccination is recommended when a child or adult is thought to have an increased risk of coming into contact with TB. The available BCG vaccine is safe, effective and remains the cornerstone of TB prevention.

There is consensus that BCG vaccination of infants provides protection against disseminated TB disease (TB which spreads from lungs to other parts of the body), TB meningitis and death. Surprisingly however, the efficacy of BCG in preventing adult pulmonary TB (TB that affects the lungs) is often still denied despite a sizeable and increasing body of good quality evidence to the contrary.  Good quality evidence supports the efficacy of BCG vaccination in the prevention of adult pulmonary TB. For more information see this paper: https://www.ijidonline.com/article/S1201-9712(19)30100-6/fulltext

If BCG vaccine cannot be given at birth, it should be given at the earliest opportunity thereafter and should not be delayed, in order to protect the child before exposure to infection occurs (WHO Position Paper on BCG vaccine, 2018)

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What is TB?

TB is a bacterial infection. Anyone can catch TB by breathing in the bacteria that cause it. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment.

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Who should be offered BCG vaccination?

National Institute for Health and Care Excellence  (NICE) recommends that BCG vaccination should be offered to:

1) newborn babies if:

• they were born in an area where rates of TB are high

• 1 or more of their parents or grandparents were born in a country where TB is widespread 

• someone in their family has had TB in the past 5 year

2) children who are 15 or under who weren’t vaccinated as newborn babies and who may be at higher risk of TB

3) people who are 35 or under who haven’t been vaccinated before and have had a negative Mantoux test result if they:

• have been in close contact with someone with TB affecting their lungs or larynx
• have come to live in the UK from areas where TB is widespread
• work with animals that can get TB (such as chimpanzees or cows)
• work in prisons, homes for older people, or hostels for refugees, asylum seekers or homeless people
• plan to live or work for more than 3 months in a country where TB is widespread

4) people who haven’t been vaccinated before and have had a negative Mantoux test and work regularly with patients or clinical specimens.

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You or your child should NOT be vaccinated with BCG Vaccine AJV:

− If you have been skin tested for TB infection and the test was found positive vaccination is not required. Vaccination may cause a severe local reaction in that case

− If you are receiving medical treatment against TB

− If you have known allergies to any of the excipients in the vaccine (listed in section 6 here)

− If you are suffering from an acute severe febrile illness or generalised skin infection. In these cases vaccination should be postponed

− If you have a weakened resistance toward infections due to a disease in/of your immune system

− If you are receiving medical treatment that affects the immune response, e.g. corticosteroids or radiotherapy

− If you have been exposed to immunosuppressive treatment in utero or via breast-feeding, (e.g. treatment with TNF-α antagonists)

− If you are suffering from any malignant conditions, (e.g. lymphoma, leukaemia or Hodgkin’s disease)

− If your immune status is in question

− If you are infected with HIV

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The burden of TB in London

TB is a significant public health challenge in London. The city accounts for almost 35 % of all cases of TB in England.

In 2019, the number of people notified with TB in England rose for the first time in 9 years, from 4,615 in 2018 to 4,725 in 2019; a rise of 2.4%.

For over a decade, London has had the dubious title of ‘TB capital of Western Europe’.

The London areas with annual TB rate higher than total London average includes (descending order): Newham, Brent, Ealing, Redbridge, Hounslow, Harrow, Barking & Dagenham, Waltham Forest, Hillingdon, Tower Hamlets, Greenwich and Hackney.

Because of large cross-boundary movements in London, there is an argument for universal BCG vaccination for all children in all areas of London.

Three-year average number of people with TB and rates in London 2016 to 2018

Local authority	Average annual number of people	Average annual rate per 100,000
Newham	172	49.3
Brent	150	45.6
Ealing	125	36.4
Redbridge	107	35.4
Hounslow	93	34.5
Harrow	79	31.6
Barking and Dagenham	58	27.4
Waltham Forest	71	25.7
Hillingdon	76	25
Tower Hamlets	72	23.4
Greenwich	66	23.3
Hackney	62	22.3

Local authority	Average annual number of people	Average annual rate per 100,000
Haringey	59	21.7
City of London	2	21.2
Southwark	64	20.5
Croydon	74	19.2
Lewisham	55	18.1
Enfield	60	18.1
Merton	36	17.3
Barnet	64	16.6
Lambeth	52	16.1
Hammersmith and Fulham	29	16
Islington	38	16
Camden	39	15.4
Kensington and Chelsea	24	15.1
Wandsworth	49	15
Westminster	37	14.8
Bexley	29	11.8
Sutton	21	10.5
Havering	27	10.4
Kingston upon Thames	11	6.5
Bromley	21	6.4
Richmond upon Thames	12	6
London	1932	21.9

https://www.gov.uk/government/publications/tuberculosis-in-england-annual-report

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BCG vaccination by the NHS

In the UK, the TB vaccine is not currently part of the NHS routine immunisation schedule in England .

On the NHS, BCG is offered to people who are at higher risk of TB as part of a selective immunisation programme:

• Infants in areas of the country with TB incidence >= 40/100,000
• Infants with a parent or grandparent born in a high incidence country (Where the annual incidence of TB is >= 40/100,000 – see www.gov.uk/government/publications/tuberculosis-tb-by-country-rates-per-100000-people )

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Are there any side effects?

Immediately after the injection, a raised blister will appear. Within two to six weeks of the injection a small spot will appear. This may be quite sore for a few days, but it should gradually heal if you don’t cover it. It may leave a small scar.
Occasionally, your baby may develop a shallow sore where they had the injection. If this is oozing fluid and needs to be covered, use a dry dressing – never a plaster – until a scab forms. This sore may take as long as several months to heal.

If you are worried or you think the sore has become infected, see your doctor.

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There was no scar or blister after my child’s BCG jab. Did it work?

A raised blister will appear in most people vaccinated with BCG, but not everyone. If your child did not have this reaction to the vaccine, it does not mean that they have not responded to it. There’s no need to vaccinate with BCG a second time.

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Why is it advised that BCG is always given in the left upper arm?

There is no reason, from a technical or efficacy point of view, that BCG cannot be given in either arm. By convention, it is given in the left upper arm to make it easier to find the scar later in life.

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Skin test for TB infection (Mantoux Test)

The Mantoux test (also called tuberculin skin test – TST) is used as a screening test for TB infection or disease and as an aid to diagnosis. The local skin reaction to tuberculin purified protein derivative (PPD) injected into the skin is used to assess an individual’s sensitivity to tuberculin protein. The greater the reaction, the more likely it is that an individual is infected or has active TB disease.  If you have a very strong skin reaction, you may need a chest X-ray to confirm whether you have active TB disease.  If you’ve had the BCG vaccination, you may have a mild skin reaction to the Mantoux test. This does not necessarily mean you have latent TB.

A small amount of harmless TB protein is injected under the skin (you can’t catch the disease from this test). The area is checked to see if your body has reacted to the TB protein 48–72 hours later.

We use Tuberculin PPD supplied by AJ Vaccines which is the standard Mantoux test in the UK. 

BCG should not be administered to an individual with a positive Mantoux test – it is unnecessary and may cause a more severe local reaction. Those with a positive Mantoux tuberculin skin test are referred to a TB clinic for assessment of the need for further investigation and treatment.

Mantoux test is necessary prior to BCG vaccination for:
●  all individuals aged six years or over
●  infants and children under six years of age with a history of residence or prolonged stay (more than three months) in a country with an annual TB incidence of 40/100,000 or greater. 
●   those who have had close contact with a person with known TB
●   those who have a family history of TB within the last five years.

MMR vaccination and Mantoux Test can be performed on the same day. However, if a Mantoux Test has already been initiated, then MMR should be delayed until the Mantoux Test has been read unless protection against measles is required urgently. If a child has had a recent MMR, and requires a Mantoux Test, then a four week interval should be observed.

If you have a negative TB screening test result (Mantoux test or a blood test for TB) done elsewhere which is not older than 3 month, we can still do the BCG vaccination for you (please bring the results to your appointment).

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TB screening blood test: £96

This blood test is an interferon gamma release assay (IGRA) which determine from an individual’s immune response whether they have been infected (currently or previously) with TB. This blood test can be used as an alternative to the Mantoux Test and is particularly useful if you previously had the BCG vaccination – the Mantoux test may not be reliable in these cases.  Turnaround time: 3 days.

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We provide certification of your TB screening test, if required for visa or occupational purposes at no additional charge.

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The information in this page are from the Public Health England and  the NHS Choices website.

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To book an in-clinic appointment call: 020 7435 7075

To arrange a home visit email your post code to: info@hhpharmacy.co.uk

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